| Comparison of low-dose aspirin and coronary vasodilators in acute unstable angina. | |
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MedLine Citation:
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PMID: 2403867 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Episodic platelet activation has been shown to occur in unstable angina, and aspirin should have an important therapeutic role in the management of these patients. The response to aspirin alone or to aspirin in combination with vasodilators such as heparin and beta-blockers has been assessed in 41 patients with unstable angina. Therapy was added sequentially in the event of recurrence of transient myocardial ischemia. Patients were randomly assigned to two groups. Group 1 (21 patients) received an intravenous infusion of isosorbide dinitrate and oral diltiazem, and group 2 (20 patients) received intravenous aspirin (60 mg the first day and 20 mg on successive days). This dose of aspirin reduced serum thromboxane B2 from 160 +/- 88 ng/ml (mean +/- SD) to undetectable values (less than 6 ng/ml, p less than 0.01). If episodes of ischemic ST segment shift continued, the therapy of group 1 was added to that of group 2 or vice versa; if further ST segment changes were documented, intravenous heparin and oral beta-blockers were added; if episodes of myocardial ischemia persisted, urgent coronary arteriography and myocardial revascularization were performed. Nine patients in group 1 and six in group 2 (p = 0.8) had no further episodes of myocardial ischemia on their initial therapy; 12 additional patients had no further episodes when taking combined therapy of aspirin and vasodilators. Thus, the administration of aspirin alone was not superior to coronary dilators; 30% of all patients continued to have episodes of myocardial ischemia or had a myocardial infarction develop when heparin and beta-blockers were added. Myocardial infarction occurred in one patient on vasodilator therapy alone, in two on combined therapy, and in two on full therapy. These results suggest that in some patients, the stimulus to coronary thrombosis and vasoconstriction occasionally becomes so strong that it cannot be inhibited by certain antagonist drugs. The unstable tendency to continuation of ischemia or evolution to myocardial infarction is not related to the severity of the persisting stenosis. Those patients not promptly responding to combined therapy immediately from admission should have early coronary angiography and aggressive treatment. |
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Authors:
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M Vejar; D Hackett; C Brunelli; P Spallarossa; M Ianetti; A R Galassi; D Lipkin; S Caponnetto; C Patrono; A Maseri |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Circulation Volume: 81 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1990 Jan |
Date Detail:
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Created Date: 1990-02-20 Completed Date: 1990-02-20 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: I4-11; discussion I22-3 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Research Unit Royal Postgraduate Medical School, Hammersmith Hospital, London, UK. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angina Pectoris
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drug therapy* Angina, Unstable / drug therapy* Aspirin / therapeutic use* Diltiazem / therapeutic use* Drug Therapy, Combination Electrocardiography Exercise Test Female Humans Isosorbide Dinitrate / therapeutic use* Male Middle Aged Platelet Aggregation / drug effects Randomized Controlled Trials as Topic Thromboxane A2 / antagonists & inhibitors* Thromboxane B2 / blood |
| Chemical | |
Reg. No./Substance:
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42399-41-7/Diltiazem; 50-78-2/Aspirin; 54397-85-2/Thromboxane B2; 57576-52-0/Thromboxane A2; 87-33-2/Isosorbide Dinitrate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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